<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    {:token()}
    <input type="hidden" name="row[itemids]" value="{$row.itemids|htmlentities}" />

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clinicname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clinicname" class="form-control" name="row[clinicname]" type="text" value="{$row.clinicname|htmlentities}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Itemids')}:</label>
        <div class="col-xs-12 col-sm-8">
            <span class="text-muted"><input type="checkbox" name="" id="expandall" /> <label for="expandall"><small>展开全部</small></label></span>
            <div id="treeview"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Totalprice')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-totalprice" class="form-control" step="0.01" name="row[totalprice]" type="number" value="{$row.totalprice|htmlentities}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-date" class="form-control" name="row[date]" type="text" value="{$row.date}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-time" class="form-control" name="row[time]" type="text" value="{$row.time}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Firstname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-firstname" class="form-control" name="row[firstname]" type="text" value="{$row.firstname|htmlentities}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lastname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lastname" class="form-control" name="row[lastname]" type="text" value="{$row.lastname|htmlentities}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Email')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-email" class="form-control" name="row[email]" type="text" value="{$row.email|htmlentities}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text" value="{$row.phone|htmlentities}" readonly>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-address" class="form-control " rows="5" name="row[address]" cols="50" readonly>{$row.address|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Message')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-message" class="form-control " rows="5" name="row[message]" cols="50" readonly>{$row.message|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="button" class="btn btn-default" onclick="Layer.closeAll();">{:__('Close')}</button>
        </div>
    </div>
</form>

<script>
    var nodeData = JSON.parse('{:json_encode($itemTreeData)}');
    var selectedIds = JSON.parse('{:json_encode($selectedItemIds)}');
    var selectedCounts = JSON.parse('{:json_encode($selectedItemCounts)}');
</script>
